JCU - January 2022 - 67

Sharma and Ajjikuttira
67
A Doppler ultrasound showed thrombosis of the entire
length of the superficial dorsal penile vein (Figure 2).
The scan also showed thrombosed distal portions of the
external pudendal vein bilaterally, which may have
explained the patient's groin pain. The deep dorsal penile
vein appeared patent. Flow was present in the cavernous
and dorsal penile arteries. Urinalysis was negative for
erythrocytes and leucocytes. The diagnosis of PMD was
confirmed on ultrasonography and we saw no benefit in
performing routine blood tests, as they would not have
changed the way we managed this presentation.
The patient had been investigated for hereditary thrombophilias
in 2008 after his mother was diagnosed with factor
V Leiden mutation following recurrent pulmonary
embolisms. Functional levels for anti-thrombin 3, protein C
(chromogenic), protein S (functional), and protein S (free)
were within normal limits. Mutation analysis for prothrombin
20210G>A was negative. Lupus anti-coagulant screen
was negative. The patient was homozygous for factor V
Leiden with APC resistance ratio of 1.05 (lab reference
>1.80). Tests for homocysteinuria are not routinely conducted
in our centre. The patient's international normalised
ratio (INR), activated partial thromboplastin time (APTT),
and partial thromboplastin time (PTT) were within normal
limits. Our patient, however, reported no previous history
of deep vein thrombosis or pulmonary embolism, making
his superficial dorsal penile vein thrombosis the first complication
of his coagulation disorder.
Figure 1. Cord-like thickening of the superficial dorsal penile
vein transversing along the entire length of the dorsal surface
of the penis.
This gentleman received a 6-week course of twice-daily
therapeutic 1 mg/kg low molecular weight heparin subcutaneous
injections in consultation with a haematologist. He
was discharged home with simple analgesia (paracetamol
and ibuprofen) and a prescription of oxycodone for breakthrough
pain. He was advised to abstain from sexual intercourse
until resolution of symptoms. An outpatient urology
appointment was also made.
Figure 2. Superficial dorsal penile vein transverse section at the base of the penis. Thrombus visualized within vein. No flow
demonstrated on color Doppler.

JCU - January 2022

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